Can a postgraduate course for general practitioners deliver perceived benefit for learners,patients and the NHS?: a qualitative study

The focus of continuing professional development in general practice is shifting towards professional development and away from following personal areas of interest. Previous work has suggested that much CPD has not had an obvious impact in the three areas of professional development: the needs of individual doctors, patients and the needs of the NHS. We report on the results of a programme of study where developments in all three were perceived as being achieved. This outcome was realized by basing learning around real problems course members encountered in their daily work, using these real situations to identify theory, then reinforcing this learning through practical application.     

What do graduates think about a two-week rational pharmacotherapy course in the fifth year of medical education?

The present study aims to assess the short- and mid-term post-graduation impact of a pharmacotherapy course in the fifth year at Marmara University School of Medicine by an objective (OSCE) and a subjective (questionnaires) evaluation. Statistical comparison of pretest, posttest-exposed case and posttest-unexposed case scores indicated both a retention and a transfer effect of training. The post-course questionnaire revealed that 95%of the students found the course useful and necessary; 97% reported that they will apply a rational pharmacotherapy approach using this model and communicate better with their patients. The post-graduation questionnaire also showed that the majority of them have learned general principles of rational pharmacotherapy(90%), gained good prescribing (90%) and communication skills (87.5%), and understood the importance of non-pharmacological treatment alternatives (100%). In general, they stated that they would apply the principles during their medical practice and they believed their colleagues would do too. In conclusion, the present study demonstrates the benefit of a clinical pharmacology programme focused on rational pharmacotherapy during the clinical years of medical education.     

What works best in a general practice specific OSCE for medical students: Mini-CEX or content-related checklists?

Abstract

Aim: To develop and pilot a General Practice (GPr) OSCE assessing medical students dealing with patient encounters, which are typical for GPr and to compare different measurement instruments (global ratings, content-specific checklists).

Methods: A blueprint based on Entrusted Professional Activities was used to develop prototypical OSCE stations. Four stations were tested with voluntary medical students. Students were videotaped and assessed with self-developed content-specific checklists, a global rating for communication skills, and mini-CEX. Results were compared according to students’ phases of studies.

Results: All three measurements were able to discriminate between clinical and pre-clinical students. Clearest results were achieved by using mini-CEX. Content-specific checklists were not able to differentiate between those groups for the more difficult stations. Inter-station reliability for the global ratings was sufficient for high-stakes exams. Students enjoyed the OSCE-setting simulating GPr consultation hours. They would prefer feedback from GPs after the OSCE and from simulated patients after each encounter.

Discussion and conclusion: Although the OSCE was short, results indicate advantages for using a global rating instead of checklists. Further research should include validating these results with a larger group of students and to find the threshold during the phases of education for switching from checklists to global ratings.     

Should a good healthcare professional be (at least a little) callous?

The term "callous" has not, to this point, been studied empirically or considered philosophically in the context of healthcare professionalism. It should be, however, because its uses seem peculiar. Sometimes "callous" is used to suggest that becoming callous confers a benefit of some protection against emotional distress, which might be considered expedient in the healthcare work environment. But, "callous" also refers to a person's unappealing demeanor of hardened insensitivity. The tension between these different moral connotations of "callous" prompts several empirical, psychological, and moral questions; I introduce and entertain a few here. I also suggest a distinction between callousness and inurement and argue for why this distinction is important to appreciate and uphold in health professions education.     

An international virtual medical school (IVIMEDS): the future for medical education?

The introduction of new learning technologies, the exponential growth of Internet usage and the advent of the World Wide Web have the potential of changing the face of higher education. There are also demands in medical education for greater globalization, for the development of a common core curriculum, for improving access to training, for more flexible and student-centred training programmes including programmes with multi-professional elements and for maintaining quality while increasing student numbers and working within financial constraints. An international virtual medical school (IVIMEDS) with a high-quality education programme embodying a hybrid model of a blended curriculum of innovative e-learning approaches and the best of traditional face-to-face teaching is one response to these challenges. Fifty leading international medical schools and institutions are participating in a feasibility study. This is exploring: innovative thinking and approaches to the new learning technologies including e-learning and virtual reality; new approaches to curriculum planning and mapping and advanced instructional design based on the use of 'reusable learning objects'; an international perspective on medical education which takes into account the trend to globalization; a flexible curriculum which meets the needs of different students and has the potential of increasing access to medicine.     

First do no harm? Female hysteria, trauma, and the (bio)logic of violence in Iraq

In Iraq, women are frequently rushed to the hospital in severe anxiety, diagnosed by medical professionals in local hospitals as "hysterical." The treatments proffered are often disturbingly violent in their own right, indicating the normalization of violence in the conflict zone and the rationalizing discourses of biomedicine to this end. Based on fieldwork in the northern Kurdish region, held to be a prosperous beacon of "postconflict" stability in an otherwise war-torn country, I consider the ways in which neoliberal interventionist agendas, medical technologies in the aftermath of war, and gendered narratives of the Kurdish nation coalesce to valorize particular forms of suffering while devaluing others as both inherently "feminine" and devoid of either agency or recuperative value. I argue that the violence of such biomedical beliefs forms a "natural" rationalized corollary of wider logics of violence in the war zone, and that both inscribe non-normative expressions of trauma in gendered terms.     

Entrustable professional activities (EPAs) for teachers in medical education: Has the time come?

On a daily basis, patients put their trust in the healthcare system for safe and high-quality healthcare. However, what evidence do we have as an educational community that our supervising faculty members are competent to fulfill this responsibility? Few, if any, requirements exist for faculty members to have continuous professional development in the field of medical education. Many faculty “love to teach”, however, this love of teaching does not make them competent to teach or assess the competence of trainees whom they supervise. Faculty members who have a significant role as a teacher in the clinical setting should be assessed with regards to their baseline competence in applicable teaching EPAs. When competence is reached, an entrustment decision can be made. Once proficient or expert, a statement of awarded responsibility (STAR) may be granted. The time has come to reach beyond the “standards” of the old adage “see one, do one, teach one” in medical education. In this personal view, the authors outline an argument for and list the potential benefits for teachers, learners, and patients when we assess clinical teachers using EPAs within a competency-based medical education framework.     

Does a new integrated PBL curriculum with specific communication skills classes produce Pre Registration House Officers (PRHOs) with improved communication skills?

Over recent years communication skills training has played an increasingly important role in UK medical curricula. When The University of Liverpool reformed its medical curriculum in 1996 from a traditional lecture-based curriculum to an integrated problem-based learning curriculum formal communication skills training was introduced into the course. The paper deals with a comparison between PRHOs' ideas about communication competencies for PRHOs who did receive communication skills training and those involved in a traditional curriculum without formal communication training. This has involved distributing questionnaires to PRHOs and their educational supervisors, holding focus groups with PRHOs and interviewing educational supervisors. Data have been collected on the last cohort of the traditional curriculum and first cohort of the new curriculum to allow comparisons between cohorts. The PRHO questionnaires show that both cohorts feel they are good communicators but the focus groups show different reasons for this. The traditional graduates feel it is because doctors are 'natural communicators' and those skills can't be taught. The PBL graduates relate their communication skills to their undergraduate tuition and found they used these techniques when communicating as PRHOs. Both the questionnaires and interviews with the consultants demonstrate they feel the communication of PRHOs has significantly improved.     

With the advent of domestic 3-dimensional (3D) printers and their associated reduced cost,is it now time for every medical school to have their own 3D printer?

Anatomy is the backbone of medical education and new techniques to improve learning are frequently explored. With the introduction of 3D printers specifically for the home market, the price of this technology has reached affordable levels. Using patient scan data, accurate 3D models can be printed that represent real human variation in anatomy to provide an innovative, inexpensive and valuable adjunct to anatomical teaching. Is it now time for every medical school to have their own 3D printer?